Too Much Heart–POTS and Other Forms of Tachycardia In Women
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Tachycardia is a long word that may sound like some complicated style of martial arts––but it’s actually a simple medical term that means having a heart rate that is above average.
It’s common, it’s more prevalent in women than men, and it can indicate many different things, from generalized anxiety to complex genetic disorders.
Today we’re going to get familiar with this term and take a look at what it means for the women who suffer from various forms of tachycardia. In this article, you’ll be given information about ways to spot tachycardia, when to take it seriously, and how to seek treatment for it if you suspect it may be part of a bigger problem.
A Heart In The Fast Lane–Why Do Some Hearts Beat So Much Faster Than Others?
On any given day, all of us experience fluctuations in our pulse rate or beats per minute (BPM). Our moods, level of physical activity, blood pressure, and our diet can have an effect on how slowly or quickly our hearts beat.
Most of us share a similar baseline, however.
This baseline is the average range a heart rate occupies, measured via BPM. A normal, healthy heart beats at around 60-100 beats per minute. If someone’s average is higher than that––if their heart beats more than 100 times per minute while they are at rest––they are suffering from tachycardia.
Usually, the above-average heart rate isn’t too dramatically beyond the normal range, and it probably won’t impact a person’s quality life in any major way. For other people with tachycardia, however, their heart’s “need for speed” can have a serious effect on their overall health and longevity. We’ll go into the specific effects later, but you should be aware that they are far-reaching and often counter-intuitive (such as lethargy or a sense of moving too slowly).
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So, what causes tachycardia? The short answer is: many things. Or rather, it can be caused by many things, and not all of them directly involve the heart itself. Common causes for tachycardia can be divided into internal and external categories.
External causes include:
Certain medications (such as amphetamines)
Overexercise
Substance abuse
Heavy drinking
Smoking
Sustained over-dependence on caffeine
Sustained exposure to frightening or stressful environments (such as fires or the scenes endured by law enforcement professionals)
Consistent overstimulation (related to above, but this can also be seen in children or adults with autism and other sensory processing disorders who may become easily stressed in a number of ‘normal’ environments)
Some of the internal causes of tachycardia include:
Heart arrhythmias present since birth (supraventricular tachycardia is the most common example of this, and it is often associated with children and infants)
High blood pressure
Anemia
Damage sustained during a previous heart attack or heart failure
Problems with the nervous system, specifically relating to the brain’s ability to communicate with the nerves that control the heart’s chambers
Severe bleeding (either internal or external)
An overactive thyroid (hyperthyroidism)
Certain inflammatory diseases such as sarcoidosis
Cardiomyopathy (a chronic disease that targets the muscles of the heart and surrounding arteries)
Genetic problems such as Postural Orthostatic Tachycardia Syndrome, or POTS
These lists are by no means exhaustive, and only a professional cardiologist or other specialist can identify specific causes on an individual basis.
Sometimes tachycardia can be cured, and at other times it can only be treated or accepted as a permanent part of life. POTS is one of the more common causes of tachycardia in women, and it’s also been the target of increased research and stronger diagnostic criteria over the past decade. For this reason, POTS is worth calling out––especially since it impacts females far more than males.
Those with POTS have an issue with blood pressure, not the heart itself. This form of tachycardia is a response-based issue that results from the body’s attempt to compensate for radical shifts in blood pressure. These shifts tend to happen when someone’s posture changes––i.e. when they stand up, lay down, or bend over.
It’s hard to test for this disorder, since it isn’t as obvious as some of the more observable causes of tachycardia (such as cardiomyopathy or deformation of the heart’s chambers). Many professionals utilize a tilt table to test for POTS, and physicians rely on patient testimony and periods of daily monitoring to arrive at a diagnosis. Other forms of tachycardia are often ruled out first, which can further lengthen the time it takes to get diagnosed.
Other types of tachycardia can be easier or harder to diagnose and treat, and each individual may display their own set of contributing factors or comorbidities. Ultimately, there are two goals involved in the treatment of tachycardia: lowering the baseline heart rate, if possible, or treating the effects an incurably fast heart rate has on one’s overall health and quality of life.
Shifted Into High Gear––The Symptoms Of Tachycardia In Women And Why They Are Frequently Overlooked
When you think of a fast heart rate, what do you tend to picture? Maybe you think of someone who’s anxious, with sweaty palms and lungs that can’t seem to get enough air. You might picture a stressed-out or angry person, too, or maybe someone in the middle of an adrenaline rush.
These are all states that can cause abnormalities in one’s heart rate, but that doesn’t mean the person has tachycardia. For that diagnosis to be given, the elevated pulse must be consistent and visible in one’s baseline BPM reading. The problem is that some people, especially women, aren’t taken as seriously when they bring up these consistently high BPM readings.
It’s common for women and girls’ tachycardia to be dismissed as psychosomatic, caused by anxiety or a stressful lifestyle. This isn’t far from the outdated diagnosis of “hysteria” that so many women endured before the advent of twenty-first-century medical practices. One reason for this phenomenon is the very nature of tachycardia, POTS, and other forms of what is known as dysautonomia. This term refers to conditions in which the autonomic nervous system––which controls things like pulse, breathing, and blood pressure––doesn’t work properly.
Dysautonomia causes myriad symptoms, and this poses problems for specialized physicians who are trying to discover one singular cause for a patient’s problems.
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The medical establishment has a long history of dumping any and all symptoms experienced by women into catch-all categories like this. Unfortunately, old habits die hard, and physicians’ biases are often unconscious. We spoke with pediatrician and POTS-sufferer Dr. Sirisha Durbhakula about this problem, and she offered some insight into the issue.
“The biggest reason that there is such a delay to diagnosis is that there is a lack of research, awareness, and education about dysautonomia for the health practitioners,” Dr. Durbhakula says. “It is a complex set of symptoms that affects almost all organ systems that blood flows to. So a patient will have gastrointestinal problems, headaches, cardiovascular symptoms, muscle aches, fatigue, brain fog, exercise intolerance, anxiety. In the US, our healthcare system is set up as specialists who know their organ system but are not well versed in the holistic body.”
“We clinicians like our diagnosis to be clean with a source and solution, so when we come across a patient like this where multiple organ systems get affected, we struggle with making the diagnosis.” - Dr. Sirisha Durbhakula
If you think you have some form of tachycardia, you’ll need to prepare to be your own advocate. Ask that all decisions and opinions are noted in your chart, and consult multiple physicians if you think one of them might be missing the mark. Most importantly, keep and maintain a record of your symptoms on a daily basis.
Symptoms of tachycardia, including POTS, may present as:
A pulse with a baseline reading of >100 BPM (this baseline should be established through regular monitoring throughout the day, including when you wake up, before and after you eat, and when you are in bed getting ready to sleep)
Dizziness
Chest pain (angina)
Chronic fatigue
Fainting or “seeing spots”
Shortness of breath (this is often experienced as an inability to fill one’s lungs to capacity or get “enough” air into the body)
Heart palpitations
Poor sleep quality
Headaches
Confusion
Changes in vision
Irregular blood pressure
Nausea
Anxiety
Pounding pulse
If you experience symptoms at certain times and not others, make sure you record that in your notes. Identify possible triggers, how often they occur, and any medications you’re taking or going off of throughout your monitoring period.
You should also note basic lifestyle information such as your rate of alcohol consumption, history of substance use in general, your sleep habits, previous illnesses, your diet habits, allergies, and anything else you feel might be affected by or cause your tachycardia.
If you suspect you might have POTS, monitor your heart rate before and after changing posture. If there’s a significant change in your BPM, note the change and provide specific BPM measurements. This is especially important when you’ve received advice from a physician that, when followed, seems to make your symptoms worse. As Dr. Durbhakula explained,
“[A] common misdiagnosis is [that] patients are deconditioned. Clinicians will push these patients into exercise regimens that actually make their symptoms worse as the heart rate goes up really high with exercise but blood flow does not get to muscles, brain, gut.”
She went on to detail some of the warning signs that indicate this kind of regimen isn’t helping, but may in fact be making the situation more difficult.
“They will often have days where they will feel awful after they do intense exercise and give up,” she explains. “POTS patients [and those with other forms of tachycardia] need a very specific exercise regimen that includes recumbent exercises that include rowing, biking, and swimming with gradual increases in heart rate.”
Recording your family’s health history and noting the details of your physical environment are also important. Ultimately, you want to be as thorough and as informed as possible before you even approach a physician.
Finally, you should be aware that a general cardiologist may not be the right person to see if you have certain forms of tachycardia. POTS, specifically, is misunderstood and often requires you to consult a POTS specialist directly. Still, a cardiologist is a good place to start, and they can certainly help you to consider and eliminate possible causes for your tachycardia.
Besting That BPM––How Tachycardia Is Treated After You’ve Been Diagnosed
It would take a whole book to detail all of the different treatments used in conjunction with tachycardia, as many are cause-specific and tie into other aspects of one’s health (such as comorbid disorders or genetic considerations).
A few recommendations stand out as being common to the treatment of multiple types of tachycardia, however. It might sound obvious, but a doctor will likely recommend that you pursue a “heart healthy” diet as step one of your treatment. Whole grains, antioxidants, and protein will all play a big role in this diet, as will the reduction of sugar, cholesterol, harmful fats, and certain kinds of carbohydrates.
For those with POTS, dietary changes may take a different form and won’t be as intuitive. One thing that’s repeatedly been shown to help ease POTS symptoms is a high-sodium diet. This helps raise and maintain blood volume, which in turn aids the body in regulating blood pressure. A POTS treatment plan will also likely include a significant focus on hydration and good sleep habits, and patients may be advised to build certain habits regarding postural changes (i.e., you may be advised to take more time to sit up or stand up after you’ve been sitting or laying down).
Other lifestyle changes may include cutting out caffeine or alcohol to some extent, pursuing specific exercise routines that will help or, at the very least, not worsen a patient’s tachycardia. In severe cases of POTS or other forms of tachycardia, beta blocker medications may be prescribed. Breathing techniques, appropriate monitoring routines, and other methods will likely play a role in treating or learning to live with tachycardia.
Some forms of tachycardia require more intensive treatment than others. Blood thinners, surgical ablation (tissue removal), radiofrequency ablation, submersion therapy, sinus massage, the use of devices such as an internal defibrillator, and physical therapy are all potential treatment options. It depends on what kind of tachycardia a patient is suffering from.
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The most important thing is for you to listen to your body and cultivate awareness of the signals it’s sending you. You have to define your own “normal” and provide physicians with context while they develop a personalized treatment plan. Since the heart impacts every other part of the body, your plan is likely to be holistic and far-reaching. Don’t be intimidated by this––instead, learn to weave these new habits, medications, or recommendations into your existing routines.
Living in the fast lane doesn’t mean you have to suffer. Give your body a chance, and don’t fall prey to the gender or racial biases that might stand between you and a useful diagnosis. Tachycardia is common, and it can be serious, so you shouldn’t give up on finding solutions to the problem.
As the old saying goes…put your heart into it! The rest of the journey can go from there.
This article was made possible by our partners at Montgomery Cardiology! Thank you for supporting women’s health, wellness, and empowerment here on The Fem Word <3
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